DOCSLIB.ORG

Interposed Bowel Loop During Percutaneous Endoscopic Gastrostomy Placement; Rare and Nightmare Irfan Ali Shera, Ram Chandra Soni

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Interposed Bowel Loop During Percutaneous Endoscopic Gastrostomy Placement; Rare and Nightmare Irfan Ali Shera, Ram Chandra Soni Published online: 2019-09-24 Case Report Interposed Bowel Loop during Percutaneous Endoscopic Gastrostomy Placement; Rare and Nightmare Irfan Ali Shera, Ram Chandra Soni Department of Percutaneous endoscopic gastrostomy (PEG) is one of common means of enteral Gastroenterology, Asian CT A nutrition in day-to-day gastroenterology practice. However, PEG is associated Institute of Medical Science, Faridabad, Haryana, India with complications such as infection, buried bumper, interposed bowel loops, BSTR and colocutaneous fistula. Herein, we present a case of PEG tube placement A with interposed bowel loop in the gastric and parietal wall that was managed conservatively. KEYWORDS: Buried bumper syndrome, gastric wall, interposed bowel, parietal wall, percutaneous endoscopic gastrostomy INTRODUCTION after tube replacement, patient presented with abdominal ercutaneous endoscopic gastrostomy (PEG) feeding pain and watery diarrhea for 1–2 weeks. His pulse Paccess is one of the widely performed endoscopic rate was 80 beats/min regular normovolemic equal procedures to fulfil nutritional needs in chronically in both limbs, blood pressure 110/80 mm Hg in all debilitated patients. Most widely used technique for limbs, general physical and systemic examination was PEG placement is gastric pull through from anterior normal. His hemoglobin was 10.5 g%, total leukocyte 3 abdominal wall. As with any invasive intervention, count was 5000/mm , serum urea was 12.8 mg/dl, PEG is also associated with complications including and serum creatinine was 1 mg/dl. Stool examination failure, infection, buried bumper, interposed bowel showed Entamoeba cysts and no trophozoites were loops, colocutaneous fistula, etc. At times, they are seen. All possible causes of persistent painful diarrhea not worrisome and can be managed with expectant were ruled out by doing stool culture, stool serology, management, but when any serious complication rises, and sigmoidoscopy. The patient was managed with the prestige of clinician is also on the verge. We are symptomatic treatment though his diarrhea did not settle. presenting a case of PEG tube placement with interposed Hence, antibiotics were instituted presuming infective bowel loop in the gastric and parietal wall that was etiology of his persistent diarrhea. managed conservatively. Even after adding antibiotics pain abdomen and diarrhea did not settle so he was subjected for imaging like X-ray CASE REPORT abdomen and computed tomography (CT) abdomen. A 78-year-old man diagnosed the case of oropharyngeal X-ray abdomen showed PEG tube migrated into large carcinoma was referred to gastroenterology clinic for bowel that was further confirmed on CT abdomen PEG tube placement to meet the nutritional need due showed interposed bowel loop between the stomach and to dysphagia and odynophagia. One year after tube anterior abdominal wall, as depicted in Figure 2a and b, placement, he presented with fever, pain abdomen, and respectively. The complication and consequences were his PEG insertion site was found infected as shown discussed with patient and attendants, and further need in Figure 1. It was managed with antiseptic dressing, parenteral antibiotics; temporary cessation of feeding Address for correspondence: Dr. Irfan Ali Shera, L‑90 Jal Vidyut Appartment, Sector 21‑C, Faridabad ‑ 121 001, and shifting on parenteral nutrition. After the antibiotic Haryana, India. course, his infection subsided. PEG feeding tube was E‑mail: [email protected] replaced, and tube feeding reinstituted. Two months This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as Access this article online appropriate credit is given and the new creations are licensed under the identical Quick Response Code: terms. Website: www.jdeonline.in For reprints contact: [email protected] How to cite this article: Shera IA, Soni RC. Interposed bowel loop during DOI: 10.4103/jde.JDE_78_17 percutaneous endoscopic gastrostomy placement; rare and nightmare. J Dig Endosc 2018;9:122-4. 122 © 2018 Journal of Digestive Endoscopy | Published by Wolters Kluwer - Medknow Shera and Soni: Interposed bowel loop during PEG placement a b Figure 2: (a) X ray showing PEG tube migrated into bowel. (b) Axial section of CT showing internal bumper of percutaneous endoscopic gastrostomy tube has been shown that is not very common.[3] Development Figure 1: Pus coming out of infected percutaneous endoscopic gastrostomy site of peritonitis and appearance of signs of systemic inflammatory response needs urgent attention. of surgery was also been discussed with the patient, Wound infection at insertion site is generally managed meanwhile if was decided after discussion with family with the institution of antibiotic therapy, and tube to retrieve internal bumper through enteral route. His removal is not necessary. It is seen in chronically PEG tube was cut down and watched for bumper to depilated patients and those who did not receive pass through enteral route. The patient was kept nil per preprocedure antibiotic prophylaxis.[4] Interposed bowel oral for 12–24 h with watchful monitoring, 12 h later, loop in between stomach and the anterior abdominal the patient passed internal bumper with feces. After wall is rarely reported complication of PEG placement.[5] 2 days on parenteral nutrition, nasojejunal feeding This can be avoided by looking transillumination and tube was inserted. Postprocedure patient remained indentation before passing the needle and adequate hemodynamically stable, and no signs of systemic gastric inflation during passing needle. Gastric colonic inflammatory response were noted. His feeding was cutaneous fistula is a late complication due to interposed restored after 1 day and the patient was discharged from bowel loops, present as fever and diarrhea. The sigmoid hospital on next day with no abdominal or systemic colon is most frequently interposed bowel loop in complaints. these conditions. Patient with this condition is usually asymptomatic or had transient fever or ileus initially DISCUSSION but at later stage present with diarrhea. Expectant [1] Percutaneous PEG first described by Gauderer et al. in management after tube removal is adequate in most of 1980 is widely performed the interventional endoscopic the cases, but persistent colocutaneous fistula may need procedure to meet long-term nutritional need in chronic surgery. debilitated patients suffering from stroke, cerebral palsy, head injuries, and advanced malignancies where There is a possible risk of tumor seeding also with PEG feeding and unmet nutritional supplementation is a big placement,[6-8] but it may be a coincidental finding also concern for long-term outcome. Replacement of these as in advanced stage almost any part, and organ can be feeding tubes is not too complex and relatively has low affected. [2] complication rate. In conclusion, our patient with diarrhea after PEG Absolute contraindication to place PEG feeding placement was diagnosed with a case of interposed tube is a significant oropharyngeal obstruction, overt bowel loops between the stomach and abdominal wall. coagulopathy or abdominal wall infections. Most of the The interposition of bowel loop in our case might have endoscopy related complications during PEG placement happened probably at the beginning of PEG insertion, and occurs due to cardiorespiratory compromise and the patient was asymptomatic until PEG site got infected. sedation-related adverse events. Esophageal perforation Although rare complication of PEG placement and can during endoscopy is rare, and most of them are located be avoided using a combination of transillumination, in cervical esophagus and incidence is <0.1%. Benign indentation and adequate air insufflation. Expectant pneumoperitoneum after PEG is common reported up management after tube removal is adequate at times, but to approximately 50% of cases and generally subsided surgical intervention may be needed in case of persistent with conservative management, but in a recent study, it SIRS and peritonitis. Journal of Digestive Endoscopy ¦ Volume 9 ¦ Issue 3 ¦ July-September 2018 123 Shera and Soni: Interposed bowel loop during PEG placement Declaration of patient consent associated with transcutaneous replacement of percutaneous The authors certify that they have obtained all appropriate gastrostomy and jejunostomy feeding devices. Gastrointest Endosc 2011;74:784-91. patient consent forms. In the form the patient(s) has/have 3. Dulabon GR, Abrams JE, Rutherford EJ. The incidence given his/her/their consent for his/her/their images and and significance of free air after percutaneous endoscopic other clinical information to be reported in the journal. gastrostomy. Am Surg 2002;68:590-3. The patients understand that their names and initials will 4. Jafri NS, Mahid SS, Minor KS, Idstein SR, Hornung CA, not be published and due efforts will be made to conceal Galandiuk S, et al. Meta-analysis: Antibiotic prophylaxis to prevent peristomal infection following percutaneous their identity, but anonymity cannot be guaranteed. endoscopic gastrostomy. Aliment Pharmacol Ther Financial support and sponsorship 2007;25:647-56. 5. Saltzberg DM, Anand K, Juvan P, Joffe I. Colocutaneous Nil. fistula: An unusual complication of percutaneous endoscopic Conflicts of interest gastrostomy. JPEN J Parenter Enteral Nutr 1987;11:86-7. There are no
Load more

Recommended publications
  • Percutaneous Endoscopic Gastrostomy in Pediatric Patients
    3 Percutaneous Endoscopic Gastrostomy in Pediatric Patients Omar I. Saadah Department of Pediatrics, Faculty of medicine, King Abdulaziz University Saudi Arabia 1. Introduction Adequate nutrition is important in the management of children with chronic illnesses. Patients who are unwilling or unable to eat will starve. Starvation depletes tissue stores, and ultimately leads to impaired organ function and tissue structure. Appropriate caloric intake enables growth, promotes tissue repair, and improve immune function. Access to the intestinal tract may be via a nasal tube or by the percutaneous route, with delivery to the stomach or jejunum. Nasogastric tubes are employed for short- term feeding, usually up to four weeks. In children requiring long term tube feeding, nasogastric feeding may be uncomfortable, disfiguring and often traumatic. Percutaneous access is usually by either endoscopic or radiological techniques. Percutaneous gastrostomy is basically a sutureless approximation of the stomach to the abdominal wall. The percutaneous endoscopic gastrostomy (PEG) becomes the most popular technique nowadays. The first PEG was performed in the pediatric operating room of University Hospitals of Cleveland on June 12, 1979 on a four-and-half-month-old child with inadequate oral intake. The procedure was performed under sedation and local anesthesia. The child did remarkably well. However, because the initial tube used was a 12F catheter with small mushroom head, external migration ensued after 3 weeks. The catheter was changed under direct visualization, using a small laparotomy (Gauderer, 2002). Since then the procedure has been adopted worldwide for both children and adults. Because the procedure is considered minimally invasive, rapid, and associated with low risk of complications, and short hospital stay, it has become the preferred method for delivering nutritional support in vulnerable pediatric patients.
    [Show full text]
  • Managing Complications of Percutaneous Tracheostomy and Gastrostomy
    5330 Review Article on Interventional Pulmonology in the Intensive Care Unit Managing complications of percutaneous tracheostomy and gastrostomy Aline N. Zouk, Hitesh Batra Division of Pulmonary, Allergy, and Critical Care Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA Contributions: (I) Conception and design: Both authors; (II) Administrative support: Both authors; (III) Provision of study materials or patients: Both authors; (IV) Collection and assembly of data: Both authors; (V) Data analysis and interpretation: Both authors; (VI) Manuscript writing: Both authors; (VII) Final approval of manuscript: Both authors. Correspondence to: Aline N. Zouk, MD. Division of Pulmonary, Allergy, and Critical Care Medicine, The University of Alabama at Birmingham, 1900 University Blvd, THT 422, Birmingham, AL 35294, USA. Email: [email protected]. Abstract: Percutaneous tracheostomy and gastrostomy are some of the most commonly performed procedures at bedside in the intensive care unit. While they are generally considered safe, they can be associated with numerous short and long-term complications, many of which can occur long after their placement and cause significant morbidity. Performers of these procedures should possess a comprehensive understanding of procedural indications and contraindications, and know how to recognize and manage complications that may arise. In this review, we highlight complications of percutaneous tracheostomy and describe strategies for their prevention and management, with a special focus on post-tracheostomy
    [Show full text]
  • 12Th KEPAN CONGRESS ABSTRACTS
    DOI: 10.5152/ClinSciNutr.2021.080321 12th KEPAN CONGRESS ABSTRACTS Selected Abstracts for Oral Presentation NUTRITION 12th KEPAN CONGRESS ABSTRACTS SS01 Predictive Effect of a New Screening Tool for Nutritional Risk in Neonatal Intensive Care Unit Nadir Yalçın1, Hasan Tolga Çelik2, Kutay Demirkan1, Şule Yiğit2 1Hacettepe University, Faculty of Pharmacy, Department of Clinical Pharmacy, Ankara, Turkey 2Hacettepe University, Faculty of Medicine, Neonatology Unit, Department of Child Health and Diseases, Ankara, Turkey Objective: Hospitalized newborns are at increased risk of malnutrition and especially preterm infants often experience postnatal growth failure.1 It was aimed to evaluate the predictive effect of malnutrition risk on the initiation of parenteral nutrition (PN) and length of stay (LOS) while patients were admitted to neonatal intensive care unit (NICU) within 24 hours. Methods: Neonatal Nutritional Screening Tool (NNST) was prospectively applied to all infants in the NICU within 24 hours of their hospitalization. The predictive effects of NNST and birth weight on LOS and PN administration were evaluated with Poisson regres- sion analysis. The study protocol was approved by the local Ethics Committee. Results: Total of 303 patients with a mean gestational age of 35 weeks and 2 days and a mean birth weight of 2552 g were prospec- tively included in the study. According to the NNST, 27 (8.9%) of the patients had a high risk, 70 (23.1%) had a moderate risk, and 206 (68.0%) had a low nutritional risk. However, PN treatment was initiated in 118 (38.9%) of the patients. Even though, the mean LOS was 14 days for all patients, LOS was 2.7 times higher in patients with a high nutritional risk compared to patients with a low nutritional risk (p<0.001).
    [Show full text]
  • Adverse Events of Upper GI Endoscopy
    GUIDELINE Adverse events of upper GI endoscopy This is one of a series of statements discussing the use of lications rely on self-reporting, and most reported data GI endoscopy in common clinical situations. The Stan- collected only from the immediate periprocedure period, dards of Practice Committee of the American Society for thus the rate of late adverse events and mortality may be Gastrointestinal Endoscopy (ASGE) prepared this text. underestimated.8,9 Major adverse events related to diag- In preparing this document, a search of the medical liter- nostic UGI endoscopy are rare and include cardiopulmo- ature was performed by using PubMed. Additional refer- nary adverse events, infection, perforation, and bleeding. ences were obtained from the bibliographies of the identi- Adverse events of ERCP and EUS are discussed in separate fied articles and from recommendations of expert ASGE documents.10,11 consultants. When few or no data exist from well-designed prospective trials, emphasis is given to results of large series and reports from recognized experts. This document is ADVERSE EVENTS ASSOCIATED WITH based on a critical review of the available data and expert DIAGNOSTIC UGI ENDOSCOPY consensus at the time that the document was drafted. Further controlled clinical studies may be needed to clar- Cardiopulmonary adverse events ify aspects of this document. This document may be re- Most UGI procedures in the United States and Europe vised as necessary to account for changes in technology, are performed with patients under sedation (moderate or 12 new data, or other aspects of clinical practice. deep). Cardiopulmonary adverse events related to seda- This document is intended to be an educational device tion and analgesia account for as much as 60% of UGI 1-4,7 to provide information that may assist endoscopists in endoscopy adverse events.
    [Show full text]
  • Trends and Outcomes of Percutaneous Endoscopic Gastrostomy in Hospitalized Patients with Malignant and Nonmalignant Ascites: a Nationwide Population Study
    ORIGINAL ARTICLE Annals of Gastroenterology (2020) 33, 1-5 Trends and outcomes of percutaneous endoscopic gastrostomy in hospitalized patients with malignant and nonmalignant ascites: a nationwide population study Ishani Shaha, Abhishek Bhurwalb, Harsh Mehtac, Daniel Maasa, Gopala Konerud, Aaron S. Cohene, Kambiz S. Kadkhodayanf Creighton University / St. Joseph’s Hospital and Medical Center, Phoenix, AZ; Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ; Saint Barnabas Medical Center, Livingston, NJ; University of Cincinnati, Cincinnati, OH; Valleywise Health, USA Abstract Background Patients with ascites resulting from chronic debilitating diseases often require non-oral enteral nutrition and undergo placement of a percutaneous endoscopic gastrostomy (PEG) tube. The aim of our study was to assess the nationwide trends and outcomes of PEG tube placement among patients with ascites. Methods Using the Nationwide Inpatient Sample (NIS), we conducted a retrospective analysis of adult patients (≥18 years) who underwent PEG tube placement (n=789,167) from 2010-2014. We divided these patients into 2 groups: with or without ascites. We compared demographics, complications, and in-hospital outcomes between the groups. STATA-13 was used for statistical analysis. Statistical significance was assigned at P<0.05. Results Patients with ascites who underwent PEG tube placement were found to have a significantly higher rate of complications, including peritonitis (7.52 vs. 0.72%; P<0.001), aspiration pneumonia (20.41 vs. 2.69%; P<0.001), hemoperitoneum (0.72 vs. 0.19%; P<0.001), procedure-related hemorrhage (1.69 vs. 0.9%; P<0.001) and esophageal perforation (0.51 vs. 0.47%; P<0.001).
    [Show full text]
  • Hospitalist Care of the Medically Complex Child
    Pediatr Clin N Am 52 (2005) 1165–1187 Hospitalist Care of the Medically Complex Child Rajendu Srivastava, MD, FRCP(C), MPHa,b,*, Bryan L. Stone, MDa, Nancy A. Murphy, MDa aDepartment of Pediatrics, University of Utah School of Medicine, 100 North Medical Drive, Salt Lake City, UT 84132, USA bInstitute for Health Care Delivery Research, Intermountain Health Care, 36 South State Street, 21st Floor, Salt Lake City, UT 84111, USA The nature of inpatient pediatrics is changing. Over the past decade, several factors have converged to influence the kinds of children currently being hospitalized. Managed care organizations have been under increasing pressure to control costs and reduce unnecessary prolonged hospital stays. Many emergency departments are using observational units to avoid hospitalizations while reserv- ing inpatient wards for higher acuity and complex patients [1]. There has been a shift in the perception in the minds of clinicians as to what constitutes an appro- priate hospital stay and what may be treated on an outpatient basis. Therapies such as home oxygen for certain pediatric conditions (eg, bronchiolitis) and home intravenous therapy for fluids and medications are being used increasingly. These developments have produced a shift in the relative proportion of otherwise healthy children with simple, self-limited acute illness being hospitalized to children with chronic illnesses presenting with acute exacerbations or conse- quences of their underlying illnesses being cared for in the hospital [2]. This article focuses on hospitalist care of these medically complex children (MCC) and provides an overview on (1) the challenges in defining this population, (2) the unique issues surrounding their inpatient care (using a family-centered care approach that includes coordinated care, minimizing secondary complications, nutritional needs, functional limitations, transdisciplinary collaboration, and pri- * Corresponding author.
    [Show full text]
  • Endoscopic Management of Gastrointestinal Motility Disorders – Part 2: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
    Published online: 2020-05-27 Guideline Endoscopic management of gastrointestinal motility disorders – part 2: European Society of Gastrointestinal Endoscopy (ESGE) Guideline Authors BasL.A.M.Weusten1,2, Maximilien Barret3,AlbertJ.Bredenoord4, Pietro Familiari5, Jean-Michel Gonzalez6,JeaninE. van Hooft4, Vicente Lorenzo-Zúñiga7,HubertLouis8,JanMartinek9, Suzanne van Meer1,2, Helmut Neumann10,Daniel Pohl11,FredericPrat3, Daniel von Renteln12, Edoardo Savarino13,RamiSweis14, Jan Tack15, Radu Tutuian16, Sauid Ishaq17 Institutions 15 Department of Gastroenterology, University Hospitals 1 Department of Gastroenterology and Hepatology, Leuven, Leuven, Belgium University Medical Center Utrecht, Utrecht University, 16 Department of Gastroenterology, University Clinic for The Netherlands Visceral Surgery and Medicine, Bern University 2 Department of Gastroenterology and Hepatology, St Hospital, Bern, Switzerland Antonius Hospital, Nieuwegein, The Netherlands 17 Department of Gastroenterology, Dudley Group NHS 3 Department of Gastroenterology and Digestive Foundation Trust and Birmingham City University, Oncology, Cochin Hospital, Assistance Publique- Birmingham, UK Hopitaux de Paris and University of Paris, France 4 Department of Gastroenterology, Amsterdam UMC, Bibliography Location AMC, Amsterdam, The Netherlands DOI https://doi.org/10.1055/a-1171-3174 5 Digestive Endoscopy Unit, Università Cattolica del Published online: 2020 | Endoscopy Sacro Cuore, Fondazione Policlinico Universitario A. © Georg Thieme Verlag KG Stuttgart · New York Gemelli,
    [Show full text]
  • Management of Dysfunctional Catheters and Tubes Inserted by Interventional Radiology
    Review Article 67 Management of Dysfunctional Catheters and Tubes Inserted by Interventional Radiology Steven Y. Huang, MD1 Bjorn I. Engstrom, MD2 Matthew P. Lungren, MD3 Charles Y. Kim, MD, FSIR4 1 Department of Interventional Radiology, The University of Texas, MD Address for correspondence CharlesY.Kim,MD,FSIR,Divisionof Anderson Cancer Center, Houston, Texas Vascular and Interventional Radiology, Department of Radiology, Duke 2 Division of Interventional Radiology, Consulting Radiologists LTD, University Medical Center, Box 3808, 2301 Erwin Road, Durham, NC Minneapolis, Minnesota 27710 (e-mail: [email protected]). 3 Department of Radiology, Stanford University Medical Center, Palo Alto, California 4 Division of Vascular and Interventional Radiology, Duke University Medical Center, Durham, North Carolina Semin Intervent Radiol 2015;32:67–77 Abstract Minimally invasive percutaneous interventions are often used for enteral nutrition, biliary and urinary diversion, intra-abdominal fluid collection drainage, and central venous access. In most cases, radiologic and endoscopic placement of catheters and tubes has replaced the comparable surgical alternative. As experience with catheters and tubes grows, it becomes increasingly evident that the interventional radiologist needs to be an expert not only on device placement but also on device management. Keywords Tube dysfunction represents the most common complication requiring repeat inter- ► catheter dysfunction vention, which can be distressing for patients and other health care professionals. This ► tube obstruction manuscript addresses the etiologies and solutions to leaking and obstructed feeding ► interventional tubes, percutaneous biliary drains, percutaneous catheter nephrostomies, and drainage radiology catheters, including abscess drains. In addition, we will address the obstructed central ► complications venous catheter. Objectives: Upon completion of this article, the reader will be minimally invasive percutaneous procedures.
    [Show full text]
  • PTH-064 Successful ERCP and Peri-Hilar Stenting in a Patient With
    Abstracts the procedure and how to take BP. A randomised study com- PTH-063 SUSPICION OF DEEP SUBMUCOSAL INVASION DURING Gut: first published as 10.1136/gutjnl-2019-BSGAbstracts.89 on 1 June 2019. Downloaded from paring patients with access to a video versus no access would ENDOSCOPIC SUBMUCOSAL DISSECTION: SIGNIFICANCE confirm the benefit of standard use of this educational tool OF THE MUSCLE-RETRACTING SIGN for patients. 1Edward J Despott, 1Alberto Murino, 1Nikolaos Lazaridis*, 1Nikolaos Koukias, 1Andrea Telese, 1Deborah Costa, 1Claudia Coppo, 1,2Yoshikazu Hayashi, 2Hironori Yamamoto. 1The Royal Free Unit for Endoscopy, The Royal Free Hospital And University College London (UCL) Institute For Liver And Digestive Health, London, UK; 2Division of Gastroenterology, Department of Medicine, Jichi Medical University, PTH-062 ENDOSCOPIC MANAGEMENT OF BURIED BUMPER Shimotsuke, Japan SYNDROME (BBS) USING A DEDICATED RESECTION DEVICE: THE ‘FLAMINGO SET’ 10.1136/gutjnl-2019-BSGAbstracts.88 Deborah Costa, Edward J Despott, Nikolaos Lazaridis*, Nikolaos Koukias, Andrea Telese, Introduction Colorectal endoscopic submucosal dissection Claudia Coppo, Alberto Murino. Royal Free Unit for Endoscopy, The Royal Free Hospital and (ESD) is a well-established minimally invasive resection techni- University College London (UCL) Institute for Liver and Digestive Health, London, UK que. When the so-called muscle-retracting (MR) sign is encountered during ESD, complete resection may not be feasi- 10.1136/gutjnl-2019-BSGAbstracts.87 ble. The pocket creation method (PCM) allows easier recogni- Introduction Buried bumper syndrome (BBS) is an uncommon tion of the submucosal space in the context of fibrosis and complication of percutaneous endoscopic gastrostomy (PEG) MR sign. To date, both magnifying endoscopy and endoscopic placement, with an incidence of 1%.
    [Show full text]
  • Percutaneous Radiologic Gastrostomy: a 12-Year Series
    Gut and Liver, Vol. 4, Suppl. 1, September 2010, pp. S44-49 original article Percutaneous Radiologic Gastrostomy: A 12-Year Series Franco Perona, Giorgio Castellazzi, Alessandro De Iuliis, and Laura Rizzo Alliance Medical Italy, Lissone, Italy Background/Aims: Interventional radiologists have come the state of the art to achieve a feeding access in played a main role in the technical evolution of gas- patients with neoplastic involvement of the head and trostomy, from the first surgical/endoscopical ap- neck or oesophagus. However, PEG may fail in patients proaches to percutaneous interventional procedures. with stenotic lesions that cannot be passed by an This study evaluated the results obtained in a 12-year endoscope. Also, obesity, gastric surgery, or other ana- series. Methods: During the period December 1996 tomical abnormalities making transillumination of the ab- to December 2008, 254 new consecutive gastro- dominal wall difficult, may lead to failure of PEG stomies and 275 replacement procedures were per- procedures.1 formed in selected patients. All of the cases were treated by a T-fastener gastropexy and tube place- As reported in the Literature surgical gastrostomy ment. The procedures were assessed by analyzing in- would be necessary in these cases. Interventional dications, patient selection, duration of the procedures, Radiology as become a valid and effective therapeutic al- and mortality. Results: All 254 first gastrostomies ternative to many pathologic conditions and percutaneous were successful; replacement procedures were also radiological gastrostomy (PRG) represents an alternative successfully performed. One (0.2%) patient with se- that avoids both surgery and endoscopy.1 vere neurologic disorders died after the procedure Despite encouraging results in literature, this method without signs of procedure-related complications, and has not yet gained widespread clinical acceptance.
    [Show full text]
  • Centered You’Ll Explore Today’S Most Pressing Topics and Exciting New on Developments with Leaders from Around the Globe in Gastroenterology
    mdedge.com/gihepnews February 2021 Volume 15 / Number 2 COVID-19 vaccines: INSIDE FROM THE AGA Are they safe for JOURNALS Pruritus in cholangiopathies immunocompromised Bezafibrate seems able AROLINA to help with “worst itch C possible.” • 6 ORTH patients? N OF BY ROXANNE NELSON, dose administration of the RN, BSN NIVERSITY /U MDedge News vaccine has been pegged Lessons in feeding at 95.0%, and the FDA has tubes TRICKLAND S - said that the 95% credible Training might not have RIAN covered it all. • 12 B Cality,oronavirus as they vaccines are interval for the vaccine Dr. Anne F. Peery, of University of North Carolina, Chapel Hill, have become a re clinicalefficacy trials,was 90.3%-97.6%. whether for recommends against surgery in certain patients. authorized for use in a But as with many initial GI ONCOLOGY growingnow being number approved of coun- and populations were repre- CRC in younger adults AGA Clinical Practice Update tries including the United senteddrugs or in vaccines, the trial cohort,not all Rates may be lower in adults under 50 than previously reported. • 15 Medical management of issuedStates. emergencyThe U.S. Food autho- and including individuals who rizationDrug Administration for the use of has the isare largely immunocompromised. unknown how ENDOSCOPY - As of December 2020, it- DOACs in elective colonic diverticulitis cine may be in this large procedures COVID-19 vaccine pro population,safe or effective many the of vacwhom It looks like they’re as BY AMY KARON duced by Pfizer and Bio- are at high risk for serious safe as vitamin K MDedge News NTech.
    [Show full text]
  • One Line Questions - Curiosities Sunday, September 9, 2018 12:22
    One line questions - curiosities Sunday, September 9, 2018 12:22 - acinar cell carcinoma of pancreas. Panniculitis, second most common, rx surgery poor outcome AIP - type 1, sausage shaped pancreas, not duct centric, path LPSP, relapses, systemic, igG4 elevated 65% time, stringy duct, (may have clinical scenario or parotid affected) Type 2. Duct centric, local, IgG4 normal, bx granulocyte epithelial lesion, associated with UC, low recurrence rate, rx steroids MCT- women, 50,s, size critical 3cm, calcification in wall, If communicates with duct IPMN. high cea in MCT Serous cystadenoma - central scar in 20% of cases Fertility Workup and pancreatitis, CYSTIC fibrosis, recessive and sweat chloride test PRSS or abn cationic trypsinogen gene, hereditary pancreatitis, AD (autosomal dominant). SPINK - tropical pancreatitis AR Schwachman Diamond syndrome SDS - second most common inherited pancreatic insufficiency, respiratory tract infection and bone marrow issues including AML. AR Bilirubin more than 4 and dilated ducts ERCP Skin lesion plus hypervascular mass - glucaganoma of pancreas - gallium scan, glucagon level, necrolytic migratory erythema is characteristic (but not specific) Pancreatic cancer screening in PJ syndrome, lynch, BRAC mutations with family history (one FDR or 2 any family), p16 with FDR Hypercontractile esophagus - DCI between 5000 to 8000 rx SSRI or TCA Diffuse esophageal spasm,- normal IRP, but low latency and high DCI and few normal peristalsis Gastric band - pseudoachalasia Pancreatico - biliary maljunction - do cholecystectomy.
    [Show full text]